Seasonal allergies: Nothing to sneeze at

If you or your kids have started sniffling, sneezing and rubbing your eyes over the past few months, you’re not alone — it’s seasonal allergy time, and the transition between seasons is kicking symptoms into overdrive.

Hay fever, also called seasonal allergic rhinitis, is diagnosed when a person has allergic reactions to such substances as tree pollen, grass pollen and certain kinds of mold. Mistaking the allergen as a threat, the body’s immune system releases histamines, which cause a host of symptoms to come on suddenly, like a runny nose, itchy and watery eyes, sneezing and post-nasal drip.

Symptoms of hay fever emerge around the same time each year for those affected, said Dr. Rosa Ten, a consultant in the Allergy and Immunology Division of the University of California, San Francisco.

“Hay fever is very seasonal,” she said. “During springtime, it may be an allergy to trees; during summer and fall, it may be an allergy to grass.”

And while Woody Allen may have us believe that Jews are disproportionately affected by allergies, in fact the American Academy of Allergy, Asthma & Immunology estimates that almost 55 percent of the entire U.S. population tests positive to one or more allergens. According to the American College of Allergy, Asthma & Immunology, between 10 and 30 percent of adults and up to 40 percent of children have seasonal allergies.

Dr. Taylor Doherty, an assistant professor of medicine in the Department of Allergy and Immunology at the University of California, San Diego, said hay fever usually shows up in kids by the time they’re 10 years old. It occasionally resolves on its own, but more often than not, those affected retain their allergies into adulthood.

Many don’t get the medical care they need, he said. Untreated allergies can cause more than just annoyance — nasal congestion can prevent good sleep, and common over-the-counter medications can cause drowsiness.

“People just sort of live with their allergies and don’t realize what kind of problems they cause,” Taylor added.

Rather than ignoring symptoms or hoping they’ll go away on their own, both Ten and Doherty suggest visiting an allergist if signs like watery eyes or congestion occur around the same time each year or if they persist for longer than a week.

“Hay fever lasts for a few months,” Ten said, “so if a person is congested, has a runny nose or is sneezing for several weeks or months, that’s probably allergies.”

For parents, Doherty suggests bringing a child to the doctor if he or she isn’t sleeping well, is breathing excessively through the mouth or has developed a wheeze or cough.

Once a patient has met with a doctor, determining the best course of action to treat allergies hinges directly on an accurate diagnosis, Doherty said. There are a number of different kinds of plant pollens, as well as molds and other outdoor allergens, and most people suffering from hay fever are allergic to only a few.

“One of the misconceptions about allergies is that if someone is an allergic person, they are allergic to everything, but that’s really not true,” he said. “There is a lot of variability among patients — for instance, many have a specific outdoor trigger as well as a specific indoor trigger, and that’s why testing is so important.”

To find a patient’s triggers, allergists will perform one of a number of tests. According to the National Institutes of Health, the most common form of allergy testing is a skin test, which can be done by pricking the skin after an allergen has been applied to the area, wearing a patch containing an allergen, or injecting an allergen directly into the skin.

“If the patient is allergic to that particular allergen, within 15 minutes they will develop a hive,” Ten said. “If they are not allergic, they will have no reaction.”

Once an allergen has been identified, the first place to start in combating symptoms is avoiding it — or, Ten said, “find out what you can do in the environment to prevent exposure.”

That might mean dusting and cleaning up pet hair regularly, or keeping windows shut. But because exposure to the outdoors is inevitable, when it comes to hay fever, many patients turn to over-the-counter medications, prescription medications or allergy shots.

Of those treatment options, Doherty said, the best is available by prescription only.

“Far and away the best medications we have for people with hay fever are nasal steroids,” he said, which work to decrease the number of cells that become inflamed as a result of an allergen. Nasal steroids can be used preventively leading up to allergy season, and over the course of several months or years, can have a permanent effect on reducing sensitivity to allergens. 

For more immediate relief of symptoms, over-the-counter antihistamines, decongestants and nasal sprays can help, although the Department of Health and Human Services cautions that nasal decongestants should not be used for more than three days in a row because of the risk of rebound nasal congestion, a return — sometimes worse — of the original symptoms.

Certain allergies are severe enough that they won’t respond much, if at all, to attempts to control symptoms through medication. For those patients, Ten said, allergy shots — also called immunology — may be the best bet. Administered over the course of several years, allergy shots are designed to “desensitize a person, so they don’t have the allergy anymore,” she said.

Clearing the Air About Allergies

Scary statistic to contemplate: About 10 to 15 percent of kids suffer from allergies, and the rate has been rising steadily for the past 20 years. Though no one knows why allergies are skyrocketing, we do know what causes them. Allergies are an immunological “overreaction” to a substance that enters the body through airborne particles such as pollen, skin contact, or ingested foods. Though this may sound quite simple, allergies are notoriously tricky to diagnose. The symptoms are remarkably diverse, varied in degree, and easy to confuse with other ailments.

1. If your child has cold symptoms that seem to drag on forever, allergies may be the real culprit. Does your child get endless but fever-free head colds — complete with sniffling, sneezing, itchy nose, watery eyes, and noisy mouth-breathing? Could be that she’s suffering from perennial allergic rhinitis, the body’s unhappy response to such year-round allergens as dust mites and animal dander.

How to handle: Talk to your pediatrician about whether your child should be evaluated by an allergist/immunologist; a skin test can identify what triggers your child’s symptoms. Once the results are in, you can work on minimizing the presence of the offending triggers. But unless you plan to lock your child in a mold-free closet for the rest of his life, complete elimination isn’t always possible. Over-the-counter oral antihistamines and decongestants can help, but they can be sedating. Ask your doctor whether the prescription drug Claritin, a nonsedating antihistamine, is an option; it’s approved for use by children age 6 and older.

2. If your child experiences these same symptoms, but they always strike in spring or summertime, you’re probably dealing with seasonal allergic rhinitis. Sometimes inaccurately called hay fever, this kind of allergy can actually be triggered by an array of pollens that become airborne as plants bloom. Need further help diagnosing your child? Look for this give-away, says Dr. June Engel, a biochemist and author of “The Complete Allergy Book”: Since your child’s nose will be itching like crazy, he may well do what’s known as “the allergic salute” — he’ll rub the palm of his hand upward against the tip of his nose to relieve the itching.

How to handle: Electric bills be damned: You may want to shut the windows and run air-conditioning during the height of the season to minimize pollen entering your home, says Dr. Francis V. Adams, pulmonary specialist and assistant professor of clinical medicine at New York University Medical School. Check with your pediatrician for advice on which antihistamines to try, and keep in mind that this medication actually prevents symptoms rather than cures them, so use them at the first hint of seasonal rhinitis.

3. Wheezing, coughing, tightness of the chest, and shortness of breath are usually hallmarks of asthma, an allergic condition in which the bronchial tubes narrow and the lungs become congested due to inflammation. Triggers may be anything from dust mites to mold to animal dander to cigarette smoke. Complicating matters still more, exercise has been known to bring on episodes, and in about 80 percent of cases, a viral infection will kick off the reaction. Typically, a child with asthma will experience his first symptoms before age 3.

How to handle: If your child wheezes or you have any other reason to suspect asthma, contact your pediatrician right away.

Obviously, you’ll want to keep your child away from the specific allergens and irritants as much as possible (warning: this may mean finding the family pet a new home). Beyond that, your child should have a bronchodilator spray available to be used whenever he feels wheezy and take an anti-inflammatory drug on a regular basis to keep his airways open. If your child ever seems to be struggling for breath and his medication doesn’t bring relief, bring him to the emergency room immediately.

4. When raised red patches crop up on your child’s skin, you’re probably dealing with hives. Hives can be an allergic reaction, commonly to an insect sting or food (peanuts, for instance).

How to handle: Of course, avoiding your child’s triggers is the best defense. But if your child is afflicted, be on the lookout for those cases of hives that can turn deadly: “If your kid brushes up against a tree and gets only a hive or two, it’s nothing to be concerned about; treat the itchiness with an over-the-counter oral antihistamine such as Benadryl,” says Dr. Jack Becker, chief of the allergy section at St. Christopher’s Hospital for Children in Philadelphia. “But if all of a sudden he feels funny — that’s how a child will typically describe the sensation — has trouble breathing and is breaking out in hives all over, that’s extremely serious.”

This can progress to a potentially deadly condition known as anaphylactic shock, in which the tongue and throat swell up, cutting off the child’s air supply. If your child ever does show these symptoms, call for an ambulance immediately.

The deadly stage of the reaction might not hit until 10 hours later — when you mistakenly think everything’s back to normal. Also, get a Medic Alert bracelet or some other kind of identification that will let emergency workers know what the problem is in case you’re not present.

Beth Levine is a writer whose essays have appeared in Redbook, Woman’s Day, Family Circle, the Chicago Tribune, USA Weekend and Newsday.